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Skills
- Denial management and appeals
- Claims follow-up and error resolution
- Proactive tracking of claim statuses
- Training and mentoring junior staff
- CPT coding proficiency
- Medical terminology fluency
- Reimbursement rate optimization
- Medical billing and coding
- First-pass claim approval optimization
- Strong attention to detail
Work Experiences
- Addressed patient concerns.
- Trained junior billing staff on [Billing Software].
- Reduced time spent on collections by [Number] hours per week.
- Accurately posted payments and adjustments via Electronic Remittance Advice (ERA), reducing unapplied payments by [Percentage]%.
- Contributed to the department receiving the [Award] for accuracy.
- Contributed to a revenue increase of $[Amount].
- Built a comprehensive appeal process protocol.
- Resolved claim discrepancies efficiently.
- Led a cross-functional team to review revenue cycle processes, which resulted in a [Percentage]% improvement in the efficiency of claims handling.
- Reviewed revenue cycle processes.
Summaries
- Ensured accurate claim submissions.
- Negotiated agreements for claim processing.
- Skilled in claims follow-up.
- Proficient in managing large volumes of claims, processing over [Number] claims weekly with a [Percentage]% accuracy rate, while adhering to HIPAA and other regulatory standards.
- Led to quicker reimbursements.
- Achieved a [Percentage]% accuracy rate.
- Implemented effective claim resolution strategies.
- Secured reimbursement for high-value claims worth $[Amount].
- Strategically enhanced payer contract terms, improving payment turnaround times and increasing collections by $[Amount] in [Number] month period.
- Secured timely submission of claims.
Accomplishments
- Enhanced patient satisfaction through prompt resolution of billing inquiries, maintaining a [Percentage]% positive feedback rate.
- Collaborated with the front-office teams to streamline patient registration, reducing initial claim denial by [Percentage]%.
- Gained proficiency in [Billing Software], which contributed to reducing claim errors and denials by [Percentage] while ensuring timely follow-ups.
- Successfully reconciled patient accounts, accurately posting payments and adjustments using [System], reducing unapplied payments by [Percentage] over a [Year]-year period.
- Provided staff training that reduced claim rejections by [Percentage]% over [Time frame] and increased overall billing team productivity.
- Optimized billing workflow by implementing [Technology] to track and update payer contracts in real time, increasing revenue by [Percentage] due to better negotiation.
- Reduced patient invoice backlog by [Percentage]% through a process improvement initiative, resulting in improved patient satisfaction.
- Successfully resolved [Percentage]% of billed claim disputes within the first follow-up, improving the overall revenue cycle.
- Revised and updated payer contracts, resulting in an average increase of [Percentage]% in reimbursement rates and overall department revenue.
- Played a key role in the reduction of account receivables by [Percentage]% by expediting insurance follow-ups on overdue claims.
Affiliations
- American Board of Quality Assurance and Utilization Review Physicians (ABQAURP)
- National Advisory Board for Health Informatics and Information Management (HIM)
- Local Medical Billing and Coding Chapters in [Location]
- Healthcare Financial Management Association (HFMA)
- The Medi-Cal Billing Advocacy Group
- Association for Healthcare Documentation Integrity (AHDI)
- Association of Medical Auditors and Coders (AMAC)
- American Hospital Association (AHA) Affiliate Program
- Medical Group Management Association (MGMA)
- National Association of Healthcare Revenue Integrity Professionals
Certifications
- Certified Inpatient Coder (CIC) by AAPC
- HIPAA Professional (HIPAAP) Certification
- Healthcare Billing and Reimbursement Certificate by [Training Program]
- Certified Medical Reimbursement Specialist (CMRS)
- Advanced Medical Billing Specialist Certification (AMBS) by MAB
- Certified Professional Biller (CPB) by AAPC
- ICD-10-CM Proficiency Certification by HCP
- Registered Health Information Technician (RHIT) by AHIMA
- Certified Healthcare Access Manager (CHAM) by NAHAM
- Certified Compliance Technician (CCT) by MAB
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